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1093792392

NPI Code Detail

MEDICARE: RAPHAEL G SMITH PSY D, HSPP

MEDICARE: RAPHAEL G SMITH PSY D, HSPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	20041042A	IN
2	103TC0700X	Clinical Psychologist	2009038103	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	343420	OTHER	IN	MHN
2	000000188733	OTHER	IN	ANTHEM BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093792392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAPHAEL G SMITH PSY D, HSPP

Provider Business Mailing Address
First Line	:	4044 CENTRAL ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2228
Country	:	US
Telephone Number	:	816-960-4525
Fax Number	:

Provider Business Practice Location Address
First Line	:	4044 CENTRAL ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2228
Country	:	US
Telephone Number	:	816-960-4525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	02/11/2010

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Directions to “ RAPHAEL G SMITH PSY D, HSPP” Practice Location

Language	Start Address	Practice Location

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